A majority of infrastructure in the US makes it extremely hard to be healthy. Activity and healthy foods isn’t integrated into daily life. For example, you can’t just walk to the grocery store or other things in most places. And if you live in a bad neighborhood, you can’t feel safe going walking or running. Living in a walkable, safe, and nice area is out of reach for a lot of people. This makes it hard for people when activity isn’t the default.
There's also seems to be a cultural stigma against walking, although I don't know how widespread it is. When I lived in California, people would actually laugh at me for walking places. "Only homeless people walk", I was told.
There also is the the mental trap of what I call "car think" which happens to me whenever I have a car readily available. Distances that were no problem walking creepingly become unimaginable as the (contestable) comfort of a readily available car gets normalized. I can only imagine that this effect gets worse when it's your own car with "sunk cost" as part of the equation. I'm always happy when I get back to "city normal". Walking is awesome.
The good thing about cities is they make parking so freaking annoying, expensive, hazardous (small parking spaces) and time consuming that walking becomes much more tolerable.
Downside to walking is a weekly family shop isn't easy to carry around.
Nah, it’s a benefit. You need to store less, less goes to waste because it’s easier to see everything. You can buy fresher things that spoil quickly because you’re going to eat them right away.
The trick is that you pick stuff up “on your way home”, you aren’t making extra dedicated trips. Not hard to supplement with grocery deliveries these days either.
When I think back to the weekly grocery shopping I did with my parents as a kid? Those huge carts full of food, having to cover the entire store, then hauling it amd packing it in the car, then all the unpacking and organizing sorting and storing some of it in the main fridge and some in the backup fridge some in the pantry … to me that seems like way more hassle than speading the work out.
I have kids, tried different systems, more and smaller trips works for us. Probably it’s one of those things that everyone works out differently
Storing things either in the pantry or the freezer (meats/butter/etc) is the only way to take advantage of sales. Plus, it's smart emergency preparedness to have a week or two's worth of food in your house.
It takes me approximately 8 minutes to go roundtrip to the closest grocery store to me. 5 minutes if I can get what I need at a bodega-y place (so no produce, but still milk and snackfood).
it's the other way around for me. out in the suburbs a grocery run was around an hour, driving to the mall, navigating the ridiculously large hypermarket, packing the boot, driving back.
right now i live a block down from a grocery store and a grocery run is 15 minutes tops.
because grocery shopping was such a hassle in the suburbs we did it once a week and tried to buy as much as possible to avoid going back. in the city i just grab whatever is on my list walking home from the train station.
Well, they kind of do. Try to cram more spaces into a car park, and make the ramps and access points narrower. A car is a car, but the tolerances get shrunk. You do 6 point turns and suchlike.
Anything less than 1.5 miles is walkable in a reasonable amount of time, at least to me - that comes out to about a 30-45 minute "commute." The problem is that everything is so spread out (there's not that much to walk _to_), and walking paths are not guaranteed to all destinations within that distance (walking isn't even safe).
I wish American towns and cities were built in the traditional 4-over-1 style of places like Amsterdam, so that even in densely populated areas there was room for shops and restaurants that could survive off of foot traffic. When visiting old European cities not built around automotive infrastructure, it was so easy to get 5+ miles of walking in every day because everything is so close together.
Having a car is awesome also when you need it, like going grocery shopping in the rain. But having to depend on a car with no other reasonable options really sucks.
Easily within most of San Francisco. It boils down to the neighborhood you live in, but a bus or streetcar can augment the trip. The downside of doing it that way is that then you also have to endure MUNI and depending on the time of the day it can feel taxing, so it’s better if you live in one of the neighborhoods that already has a good market street (e.g. Clement & Geary in the Inner Richmond).
I live in a SoCal coastal city of 60K which has a fairly low "walk score" of 43. The services I'd need on a regular basis are in the neighborhood of a 20-45m walk (one way).
When I lived in a more car-centric city in the US, I used to get honked at while walking. It was a thing in this city to honk and/or yell at pedestrians. I’m not sure what the thinking behind that sort of behavior is.
My next-door neighbor here in California seemed kind of shocked when I told her I walked to the movie theater. It's 2 miles away, with a safe sidewalk.
Ive had people throw cans and shout at me while walking. Never understood why. Your comment brings it together for me after so many years. I wasn't homeless, just didn't have a car at the time and was used to walking long distances where I came from.
Has this gotten worse in the last 20 years, though? I think it was similarly bad around 2000, and yet, Americans have gotten less healthy over that period.
> A majority of infrastructure in the US makes it extremely hard to be healthy
This is a copout.The only hard thing about being healthy is having the discipline to do so. Certainly more than 6.8% of people have the means to have healthy diet and they choose not to. There are definitely extreme cases of poverty where it would be difficult (which people who are well above that will use as an example to make themselves feel better about their choices) but I'd argue it's still very reasonable to be able to lead a very healthy lifestyle.
We're fat as hell because we live a life of extreme abundance.
It’s not a cop out, it’s part of the variety of problems. Environment design can encourage certain habits and lifestyles. I agree that living an extreme life of abundance is also part of the problem. Though it’s definitely not the only cause.
And yet you see no obese person around in San Francisco. It’s better to expect people to not be disciplined and have a nice environment where they can have a healthy lifestyle by accident.
This may be coming from a privileged position, but I don't get the "bad neighbourhood" thing (I can also run quite fast and am generally fit and healthy, so that's also a factor). I'm also based in Australia, so our idea of "bad neighbourhood" might not even be a blip on the US scale of "bad neighbourhood".
I was working in Melbourne, staying near St. Kilda, and was told by some colleagues "don't go down street X at night", so I went down street X at night, had a nice meal there, walked back, no fucking worries at all.
Next morning I heard on the news that someone had been stabbed to death on that street within half an hour of my being out and about there.
The thing is, though, if you're not out causing trouble or selling drugs or buying drugs, or a member of the various competing underworlds, then you're likely to be totally fine. The stabbing was drug related.
It's a bad neighborhood if you're part of what makes it a bad neighborhood - in this case, at least.
I grew up in a bad neighborhood in the US and this is what it meant for us: hearing gun shots every other night, experiencing drive by’s at school, frequent helicopters looking for someone, swat team locking down our neighborhood and evacuating everyone, break-ins multiple times, being threatened at knife point by a random stranger, people putting our dumpsters on fire. Lack of opportunity because everyone around us is poor and in the same situation. No sidewalks, roads in bad condition, shitty schools.
We weren’t part of the problem, we were just kids. But it’s easy to get pulled in when you grow up like that. There’s a big difference between visiting or driving through and growing up in such a place where you feel like you always had to watch your back. Because you spend more time in such a place, it increases your chances of bad things happening.
But it also meant, playing around the streets with the neighborhood kids, great food, neighbors giving each other things like food and essentials, a sort of camaraderie that we had each other’s back. Not everything was bad. However, you never feel truly safe.
Beyond “grabbing a bite to eat“ being a very different level risk than going out to physically exhaust yourself on foot daily, violent crime per capita in the us is several multiples higher than it is in Australia on average, and it’s not remotely evenly distributed. The place most commonly cited as the most dangerous in Australia is Rockhampton in Queensland and the only numbers I could find were from 10 years ago— 2 murders per 100k, and apparently that’s dropped considerably. By contrast, St. Louis Missouri has about four times as many people and their murder rate is about 68 per 100k. St. Louis has about the same number of murders per year as Australia on a whole. I am quite certain that your experience in a rough neighborhood in Australia is not representative of many of our rough neighborhoods here.
Feeling safe is just as important as actually being safe.
I think you partially addressed that already with the privilege part. I know my city has rough areas that definitely have an increased risk of getting mugged, robbed or just jumped for no reason. Knowing that is enough to keep me from going around there unless I have a reason.
Yeah, most people who say parts of a city are "too dangerous to walk around" are overblown, especially in major cities. There are a few cities with a few areas where you probably don't want to be walking around if you don't know the area and the people. But, 90% of the time it's just that it's an immigrant area and people are afraid of difference.
And if you think from an environmental and practical perspective: Car-centric infrastructure cause more cars and more traffic jams, with more and more pollution.
There needs to be good frequent public transport on dedicated rails or priority lanes, so it is faster than a car can be. Good bicycle infrastructure so people want to take the bike. It's crazy that many people see cycling as some kind of sport or free time activity, while it is for so many people a serious way to commute to work or get the groceries or visit family.
But it is so cultural, so embedded in society, it is probably never going to be fixed. Also probably thanks to the motorvehicle lobby.
It's also that in many places things have been built to enormous widths (with huge parking lots) but low heights. I hated living in Mountain View as walks were cumbersome. On the other hand I loved moving down to Santa Monica later where things tended to be much closer together, making walkability a real thing (which was in fact easier/more convenient than driving, at least in the downtown cores).
Exactly. Environment design can alter behaviors. If there’s a grocery store near me but no sidewalks, I have to cross a huge intersection, and there’s sketchy spaces — that’s not a good pedestrian experience at all.
Yes and no, people get stuck in economic traps of paying for things they didn't really need, and those can eliminate all free time. Also, there really is a large group of americans that still work multiple jobs and can't afford healthcare, thats a thing. Some of those are physical jobs, but many are not.
Maybe, but many people in the world are able to stay healthy without having to make the time commitment or discipline of regular explicit exercise. It just falls out of living their regular lifestyles.
I was in bad health, i.e. raised adiposity (which is a beautiful euphemism, I might add), for a while and it's because I spent so much time working to pay my bills. I had almost no time to exercise. That is especially true when I spent my free time with friends or working on hobbies. The additional stress of work and lack of time drove me to drinking which messed up my liver (was diagnosed fatty liver) and added to my bad fat metabolism. Recently, I've been taking a break from working and have had time every day to go running and go to the gym twice a week and I've dropped 7 pounds in 2 months and feel way healthier.
You're working against millions of years of evolution.
If a cave man is given the options of 4 foods, the cave man who eats the most calorifically dense food is more likely to live and have energy through the next lean time than the cave man who eats the leaves. It sucks but that's just how we're evolved and it's shockingly hard to "trick" those sense with fake sugar etc.
I'm sure you know this, but today one must learn to make smart choices in the face of modern foods which are readily available. I refrain from sugar in my diet and to me citric acid (Vitamin C powder) and sometimes vinegar hot sauce taste sweet.
Fruit, a rare treat, tastes like candy.
It depends on what you've become accustomed to eating.
Many hot peppers actually have a good bit of sugar in them. I was making some Tabasco sauce I'm the fall and the bees were very interested in it. I also grew some cayenne peppers that didn't have any heat and they were quite sweet.
Some people do seem to make it work though, going for a run with the baby (Thule strollers etc) or later on together with the kids. It's awesome to see and it still gives me hope but I have the feeling that some kids are just much easier to handle from the moment they are born. Nothing to be mad about. Just something to accept while celebrating the absolute wonder of them being with you including your survival of yet another day (without eating yet another cookie).
I assume you had the best intentions with this comment (it does probably apply to a lot of children) but it also is a top contender for that “HN comment of the day” ;)
I did that a lot with the first child. Was hard to do with two (jogging double strollers are a thing, but bulky and best with twins or similar aged kids).
When we had a third, I took my first (who was 6.5 years old) on bike rides with the youngest in the stroller. Worked ok until but a lot harder to juggle.
Pandemic helped but now that we are going back to the office (twice a week for now), morning exercise is the first thing to go (home cooked meals a close second).
Totally hear you. We just added kids 3 & 4 in the fall (twins! Yay!) and so far I’m on paternity leave and just managing a bit of a workout (push-ups, squats, etc) but I have this feeling it’s going to be really hard to balance almost anything against full time employment. I may just end up taking a 30 minute bite out of my work day and seeing how my performance reviews fair.
My struggle w/ an 18 month old is that the house is always full of 1/3 eaten plates of food, and I don't want to throw out 2/3 of a bowl of oatmeal or 2/3 of a little burrito...
I've been doing intermittent fasting and only garbage collect in the evenings, but the temptations are high when you WFH.
Once the kiddo gets older and starts going to preschool or kindergarten, you're gonna have to be okay with throwing out some half eaten kids food. That's the fastest way for me to get sick (garbage collecting my kids' dinner trays).
Like the parent comment I also have been doing garbage collection from the plate and slimming my own servings in anticipation. It seems to have worked, but now that my toddler is almost 4 I've noticed that my rate of stomach bugs has increased to levels I've never experienced. I wonder if this is the reason... I hate throwing away food so, so much.
I imagine this affects many parents. I would love to know how many parents successfully manage this (or, perhaps, success is simply defined as raising your kids well)?
You absolutely need to prioritize getting 30-60 mins of exercise at least 5 times per week. Block out time on your work calendar if you have to. The cognitive / health / mood benefits will make up for the lost time.
A home gym setup will save you the 30-40 mins to and from the gym. Barring space for any equipment / weights some exercise bands and a yoga mat will do. App based fitness classes such as AppleFitness+ also make it much much easier to program your workouts.
People seem to have all sorts of problems from having kids. Some have no problem with weight gain but their marriage falls apart. I guess I'm glad I got what I got instead of that.
Only problem is, to make a salad taste good most people add in chicken, bacon bits, cheese, egg, mayonnaise, heavy dressings and hey presto, you've got 1000 calories in there.
The "Real Men of Genius" advertising series from the late 90s touched on this very well with their "Mr. Giant Taco Salad Inventor" ad: https://www.youtube.com/watch?v=fXWq2AVlrsY
It's a funny thing. The more important you think it is, the more important it becomes. If you allow yourself to think, maybe everything doesn't need to taste decadent and delicious, and that maybe a neutral green salad can taste fresh and palatable and that's good enough, you'll find it to become true.
In theory you're not wrong, of course, but in practice "just eat salad instead of a pizza" is so simplified it's not even useful. And I can't even comprehend what's the "damn good compromise" you referred to.
You can eliminate the daily cravings with this change of habits, but you can't change the caveman psychological reaction to eating a pizza. It will always taste much better and yield way more dopamine than a green salad ever will. Much like an ex-smoker and cigarettes.
Unfortunately most people have trouble to convincing themselves that the yellow crayon tasted of bananas when they're forced to scrape wax from their teeth.
I'm not certain what value "just pretend it tastes good" has here. This surely doesnt work long term?
I'm early 50s. In my mid 40s, I had terrible cholesterol and was obese. I have a family history of heart disease, and I got scared. So I started exercising (running, then switched to alternating rowing and lifting) and lost 70lbs and reached my ideal body weight, but I didn't change my diet. My cholesterol improved, but was still not good. My doctor was talking about putting me on a statin.
Two years ago, I started dating a vegan and slowly became vegan myself and I now eat a plant based diet.
Between the exercise and the diet, my cholesterol numbers have totally turned around. My doctor commented last month at my physical that she's never seen anybody turn their cholesterol around like that without drugs.
That is awesome, congratulations on a remarkable turnaround!
Funnily, I'm kind of the opposite story -- mid-40s and fairly athletic. I run around 14 miles every other day at sub 7 pace, play other sports, and am generally in good shape and have been my whole life. My diet is mostly vegetarian without much alcohol. Trying to do everything right to live a healthy lifestyle, but my cholesterol was terrible... LDL around 240.
My doctor chalked it up to bad luck with genes. After a few months on a statin it was at 90. Since I didn't have much room to change lifestyle, I'm very thankful for drugs!
There's a big difference between "mostly vegetarian" and vegan diets, especially when it comes to cholesterol, due to the eggs, milk, and whatever else it let through in that "mostly".
edit: form those disagreeing, please let me know the flaw in my statement.
I'm interested in the effects of milk and eggs because I love both. I've cut 'pointless' sugar out of my diet the last three years and eat less meat than I used to, but I'm not ready to go vegetarian (or even vegan) yet - although the people I know who have, rave about how much better and more energised they feel.
Exactly! A friend of mine said there is nothing you can do about type 2 diabetes and I told him many people are just unwilling to come to grips with obesity and poor diet. A well planned vegan diet can prevent and manage type II diabetes by controlling your weight and sugar levels.
Being vegan or not is mostly irrelevant to diabetes. Research has shown that the most effective way to put type-2 diabetes into remission is with carbohydrate restriction. That can be done with or without eating animal products.
> White sugar (and some brown sugar) produced from sugar cane may be refined using bone char by a few sugar cane refiners.[2] For this reason white sugar from sugar cane may not be vegan. Beet sugar has never been processed with bone char and is vegan.
>White sugar (and some brown sugar) produced from sugar cane may be refined using bone char by a few sugar cane refiners.[2] For this reason white sugar from sugar cane may not be vegan. Beet sugar has never been processed with bone char and is vegan.[3]
which pretty definitively say that it's only cane sugar that might be processed that way, and beet sugar is "never" processed that way.
Am I wrong to read that to say that _some_ white sugar is vegan?
EDIT: Oh, I see the confusion. I didn't mean any beet sugar was processed that way. I only meant to dispute the claim further up that white sugar is not vegan.
She wasn't clueless. She just said that in her experience, nobody actually takes her advice to exercise and change their diet seriously and they wind up on statins.
I've met people who do this exact thing. They were clearly overweight, and we're complaining that the doctors were "offending" them my telling them they were overweight. They kept seeing different doctors, and told the same thing. They just could not find a doctor who could tell them what they wanted to hear.
Not having seen the full paper, surely the range of values that belong to "optimal" is arbitrary and if measurement error or understanding were improved, the optimal range would shrink, excluding even more people. So doesn't that make the percentage meaningless?
Yes. But the actual title is "Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018" and the major conclusion was "Between 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening." The HN title is editorialized to focus on a relatively insignificant and easy-to-quibble-with detail.
Not "surely". For something like body fat, we have a pretty good understanding and very precise measurements but the optimal range is much much bigger than that precision.
I also have a resting heart rate in the mid 50s and LDL of 46, but in my case it is because of beta blockers and 80 mg of statins daily.
3 years ago I found out I had 3 total occlusions and needed an immediate coronary artery bypass graft. 3 years later and my heart is still only half as efficient as a normal man my age because of extensive scarring! Take care of yourselves people, there is more to life than shipping software!
Count me in that 6.8%. In my 40s, resting heart rate ~50 (no it's not bradycardiac), relatively healthy weight, low LDL, low HDL, 115/70 BP.
I ride 25 miles 3/week on average and probably walk another 3 miles 3/week. Pretty much intermittent fasting (1 meal/day) plus some protein shakes.
Probably the most depressing thing to me about the US is how car-dependent almost everything else. In most places in the country you can't even have a walkable lifestyle (without driving somewhere to "hike") even if you wanted to. IMHO it's a lot harder to become unhealthy and morbidly obese if you routinely walk places.
My resting heartrate sitting at my screen is 47, and my max heartrate during Tabata workouts hits 190+. Rest to peak and peak to rest recovery is about 5 minutes.
I do six 30~40 minute plyometric/metabolic workouts per week and have had one steak in the past 4 years, and gave up bacon around 2012. I eat three low-carb squares a day, all home made, nothing from a box or pre-made. When I drink I binge, I'll have a bottle of wine in one sitting but only twice a month.
The only advantage I have over most people is I work from home so my workouts fit nicely into my schedule. If I had to work 8-5 with a commute I would find it difficult to fit the workouts in since I live far from the nearest city. Fortunately, I also have a Wegmans grocery store 5 miles away that has nice produce, and I like to cook, so eating well is easy.
Absolutely. Walking and sleeping especially — time spent burning energy in which it isn’t possible or convenient to eat. I recently read about how exercise kind of dampens appetite as well, including walking (though to a lesser degree than more intense exercise).
We should all try to walk and sleep more, it seems.
something to question, is that level of cardiovascular health necessary though? you might add 2 years to your life, but also means you're spending x times more of your productive years exercising
Driving a car to get around gets me much more time with my friends and family and myself.
1. Weight: I've been 50+ lb heavier than I am now and I, personally, hated it. It makes everything harder and that only gets worse with age;
2. Fitness: this one is (IMHO) less extreme than weight differences but if you can't walk up a flight of stairs without getting winded that's going to impact your life in negative and real ways;
3. Health: when you're young this is less of an issue but as you get older being overweight and/or unhealthy becomes a more significant risk factor for many health problems. Heart disease, strokes and a host of others;
4. Quality of life: getting fresh air, sunlight and exercise is generally good for your state of mine. At least, it's good for mine. It can help put thing sin perspective (professional and personal) and improve your mood.
YMMV
As far as time goes, this was a big motivator for IF for me. As in, the effort of preparing (or even buying) meals annoyed me. It's one of the big things I appreciated about working in tech: the free meals. Not for the quality necessarily but primarily for the convenience. I don't have to plan for (many) meals.
Treating eating as a leisure activity can be a trap too like some people have weight issues because they like food and end up treating it as a reward, which reinforces the cycle.
I'm not sure about GP, but about a decade ago I decided to stop being fat and lazy and started playing soccer, running, and later doing BJJ and some strength training (cannot seem to stick to weightlifting, but bodyweight works well for me). After that change, I slept less, but better, and had more energy throughout the day and into the night. I got more time back by being in shape than I lost from the exercise to get me there. And I was spending time with friends when I was exercising anyways (friends from before I started exercising) by joining their soccer team, going for runs and hikes and rafting trips with them, and similar things.
At work I became more productive because I wasn't struggling through half the day feeling fatigued and worn out, or pushing into a panic attack from all the caffeine needed to keep me conscious. Outside of work, despite (and as mentioned in many cases because of) the exercise I spent more time with friends and family. And I probably bought more than 2 years at the end of my life. I was on track for a heart attack in my 40s the way I was going.
I think that the bigger impact is improved quality of life when you’re old. Having a higher baseline health after 70 allows you to enjoy your later years much better. You may not live much longer but it’ll more likely be a longer period of relatively good health with a steep decline at the end as opposed to a long gradual decline where you’re able to do much less for a long period
Quality of life is usually better for those who exercise and that becomes particularly evident as people age. But either way it's literally just like a totally false tradeoff - the time I spend with people hasn't been at all compromised by exercising and you can even exercise with other people too (e.g. friends at the gym, beach, going for a run with partner etc.)
I think if you've made the choice to just not exercise you should be honest about why instead of inventing non-problems like exercise significantly reducing time spent with family and friends. I literally don't know anyone who has ever raised this as a problem. Maybe if you're exercising as an Olympic athlete...?
Exercise is a long term investment though. Life really is easier when you're fit. And all the gains you get in your younger years cannot be easily done when you're older especially for muscle mass.
This specific amount of cardio fitness is probably not strictly needed. Given the choice I believe most people should chose more strength training. But at any given time, being able to pop out at least a 5km run or equivalent is probably a good place to be.
This is the only sensible idea expressed in this entire thread. Most of you have good tech company health insurance, use it. Stop asking for health advice from engineers who read that one paper that agrees with their prejudices.
Definitely talk to your doctor but if you're highly endurant and do high-cardio exercise, it's not abnormal to have resting heart rates between 40 - 50 or even lower.
I feel folks overcomplicate this. At least for the the HN crowd, it is totally possible to eat mostly non-processed, fresh food, don't drink too much booze, and get an average of 30 minutes of incidental exercise a day. Those three things and you are head of 90% of people.
I've found most benefits that make me seem years younger are likely linked to:
- Some form of resistance training (in my case oly and general strength training)
- Walking a lot (a benefit of a walkable city) as part of routine, rather than a scheduled exercise
- Not snacking, sticking to scheduled meal times
- For me personally, intermittent fasting in the form of skipping breakfast. Not only is breakfast unnecessary for most of us, you'd be surprised by how much you can achieve fasted, you might even find an enhanced energy.
I'm sure resistance training can be substituted for other 'training' by which we mean a stimulus strong enough to lead to an adaptation. With the adaptation to the exercise comes some of the benefits - like optimal cardiometabolic health.
Happy to be in the 6.8% group. Started on the carnivore diet about 7 years ago. I had been a vegan for years before that, but my health deteriorated badly because of this. I also exercise and fast regularly. I have never been in better health, and this is confirmed with blood work every 6 months.
I’m amazed at how well carnivore works for me. I started a few days ago. Before that I’d been throwing up 5+ times a day, every day, for months. My doctor shrugged and had no idea what to do. Even Zofran didn’t help.
Well that indeed sounds amazing. Great that you are already feeling better.
Because of my past, I'm often contacted by recovering ex-vegans in my area. I immediately get them started on the carnivore diet and within a week or two, most will come back, often with tears in their eyes, to tell me that they finally begin to feel normal again, really a joy to experience.
From the Method section, just a few paras in (I just clicked on the link provided, I do not subscribe to any journals): We assessed proportions of adults with optimal cardiometabolic health, based on adiposity, blood glucose, blood lipids, blood pressure, and clinical CVD; and optimal, intermediate, and poor levels of each component among 55,081 U.S. adults in the National Health and Nutrition Examination Survey.
That doesn't actually explain anything, though. What is "optimal" in each of those categories and why is that level optimal as opposed to any other one?
What is their definition of optimal cardiometabolic health? I don’t see a mention of VO2 max. Yeah it’s normal weight and I would think it is an average or better VO2 max for your age group.
I always wonder if one can take solace in the fact that one has a problem that everybody else also is dealing with/will be dealing with and so there is a huge financial (and quite frankly medically selfish) incentive to solve.
The opposite of that is that having such thoughts immediately makes me feel a shitty person because financial resources are not infinite and if they are thrown at solving the problem that everybody is dealing with it means that people with rare diseases are getting the short hand of the stick.
There isn’t a financial incentive to solve it. There is one to treat it. Insulin, blood pressure meds, statins for cholesterol, cardiac stints are all big business.
So was the ice business, not to mention the salt business, the ice cartel and the salt cartel were dominating but the person who invented the refrigerator put them both out of business in one swoop and managed to subtract all their wealth/ status from them.
In this case there is also the incentive to solve it if anything out of selfishness given that everybody at some point develops cardiometabolic problems
It seems to me that the vast bulk of their business is made possible by the fact that our alternative is to dramatically improve our diets, sleep, and exercise regimens.
Studies seem to show that each of these often have meaningful effects on preventing, stopping and even reversing common diseases.
This is all really hard for people to do, though. There’s a lot working against us. It’s hard to see why we should do it at the individual level — it’s hard to believe these changes will make a meaningful difference.
But you’re right that there’s no financial incentive there. Not at all. There is for each of us, and here in Canada there is an incentive to reduce medical spending, but pharmaceutical companies stand to gain nothing and lose so much.
It’s hard to imagine this changing much, but what a difference it would make. Life could be so much different for so many of us.
Sure, current leading pharma companies will keep making money if they don’t invent an obesity cure. But most people aren’t in the pharma business, and even most scientists with the relevant expertise aren’t pharma magnates. If there were some one-and-done obesity chemical that no drug company bothered to market yet, it would actually be a great act of charity to the industry for everyone to unanimously ignore that opportunity. Realistically, there are a bunch of also-ran pharma companies who would jump at the chance to be the exclusive seller of this miracle drug for 17 years until the patent ran out.
> I always wonder if one can take solace in the fact that one has a problem that everybody else also is dealing with/will be dealing with and so there is a huge financial (and quite frankly medically selfish) incentive to solve.
Not really; no one has cracked old age, for example. There's no cure for diabetes, either.
cuts both ways with rare diseases. mine's progressed to the point where I need a wheelchair outside the house. I do daily PT, but my arms are messed up too so my exercises are necessarily very light. Wheelchair use is literally a sedentary lifestyle, so I'm at risk of all the couch-potato issues.
Considering approximately $0 has been spent on drug discovery for my disorder (genetic, rare, not fatal), I'd substantially benefit from exercise-in-a-pill drugs if those come out, as would a lot of others in my position.
HDL: 1.96 normal range 0.90-1.60 ("good" cholesterol, above high normal)
LDL: 2.19 normal range 2.00-3.40
Triglycerides: 0.54 normal range 0.60-2.30 (below low normal, lower is better)
HbA1c: 4.9% normal range 4.5-6.5% (measure of average blood sugar over about 3 months)
I had these results while I was in med school (late bloomer) and having seen a lot of lipids/HbA1c I have to say I have never seen results this good in anybody else. Yes, I am pretty proud of myself!
At one point I ran a half marathon, but that was 4-5 years previous to this. By this point I was on 20 minutes intense cardio 3x week, and heavy weights. By heavy I mean heavy for me, as in I didn't show up at the gym expect to do 3 set of 10 no matter what. If I could do 3x10 of a certain weight, it was time to up the weight for constant improvement.
I ate balanced protein and carbs with some fat, a habit I picked up from Body for Life a long time ago. I ate a lot of chicken, plenty of beef, also fish. I also love candy, and will eat a lot of it while coding or studying. Never skimped on things like popcorn, triple butter please. Love eggs. Love eating out, rich meals and dessert. I have never been vegan or vegetarian. When I really wanted to build muscle, I ate lots of meat.
For a genetic background, I have a sibling who ended up with NAFLD in their early 30s. Aunt and grandfather with T2DM. Mother is on statins now in her late 60s. Generally my family is average build, maybe a big chubbier. I would say my health is 90% effort.
I think the key is, you have to use absolutely everything you put in your body. If you are not building a stronger body with it, it's going to waste.
Congratulate your parents as well for the good genes.
> I also love candy, and will eat a lot of it while coding or studying. Never skimped on things like popcorn, triple butter please.
> I think the key is, you have to use absolutely everything you put in your body. If you are not building a stronger body with it, it's going to waste.
I mean I’m totally in the indulge in moderation crowd if only to enjoy life, but I am still at a loss how your two statements above are connected. How are you building a stronger body with the triple butter?
I added some genetic background. That definitely isn't it. Nobody else in my family has put in the effort that I have.
> How are you building a stronger body with the triple butter?
The point is that I used it all. I burned all of the calories I put into my body. Even if the calories were "crap" I burned them instead of consuming the quality protein I ingested for basic metabolic needs. My weight crept slowly upward from 155 to 165 over the course of 10 years and it was muscle, not fat.
> I added some genetic background. That definitely isn't it.
It isn’t “it”, but you sure as hell know that lipid metabolism has a considerable genetic component.
> Mother is on statins now in her late 60s.
Even with your lipid levels posted if you have even a touch of hypertension you will have an indication for statin in your late 60s based of CV risk.
Seriously I am happy that you’re physically fit and doing well not trying to diminish that - but I could not help but be amused that you’re flexing off of results seen in medical training. Granted some of us train in relatively healthy areas - but I trained and work with a patient panel with A1c often in the teens - so just the thought of gauging my own progress off that comes off somewhat sadly as ludicrously funny.
My somewhat tech related story was we recently had a transfer patient with an A1c of 127. The limit on these assays is typically around 20% - but apparently the lab interface in this case stores A1c as a signed 8 bit integer and a maxed out value as +max - after mentioning this the endocrinologist gave me a blank stare and walked away.
Well, I'm obviously discounting results that you could classify as "unhealthy" right off the bat, and I was relating it to screening lipids on healthy patients. I'm not going to flex vs a 12% a1c from a diabetic, and the point is that I have not seen better numbers in any patient. Of course these are just numbers and my health could turn bad any day, but as far as numbers go, mine are great.
My mother is on statins based on her lipids. I suppose my situation could be the result of some favorable de novo mutations, but if you look at an extended family photo I am definitely the odd one out, something that only emerged with hard work starting late in my teens. Nothing with my fitness has been a gift. I could barely run 500m in my early 20s. It was far harder for me to gain muscle than most other people at the gym. That can be discouraging, but I stuck with it all became a form of meditation and a constant in my life when other things were changing.
>> and having seen a lot of lipids/HbA1c I have to say I have never seen results this good in anybody else.
> point is that I have not seen better numbers in any patient.
Well that’s a biased or too small sample size. 2.19 is a great number for most adults (barring those with very high risk ASCVD where these days we want to squash it down much lower) - and if you were my patient I would be congratulating you but alas you are just a rando on an Internet forum where we can discuss data dispassionately and..
https://www.ahajournals.org/doi/10.1161/circ.106.25.3237
If I see only 20 patients in clinic or realistically a cohort of clinics that is representative of the American population I expect 1 or 2 to pop better numbers.
It’s better than average but not rare or uncommon by even American standards (and don’t look at the Dutch numbers if you want to feel good about yourself).
This has become quite a bizarre conversation. You seem utterly unwilling to believe that you can meet a healthy person on the internet, and even if you did, you assume it's purely genetic.
You've sent me the distribution of lipids across all age groups, done for research purposes. In clinic you rarely test anyone in those younger age groups for lipids as screening starts at 40 for men and 50 for women. So, you know, you don't see results for 20 year olds in clinic, and if you do see those results for younger people it's because they have some pretty extreme risk factors like morbid obesity. Are you ordering lipids on healthy 20 year olds?
Interesting to see that even against the youngest age group, my triglycerides are low enough to be in the 5th percentile, HDL is above 95%, and LDL below 10th percentile. Total cholesterol was 4.40 so my ratio is 2.2, which is far below average for risk. My HDL was better than 95% of Dutch teenagers and my triglycerides were better than 90% of 20-somethings.
> You seem utterly unwilling to believe that you can meet a healthy person on the internet, and even if you did, you assume it's purely genetic.
You seem to have some deep insecurities. I already acknowledged multiple times that your stats are overall consistent with good health. I lightly pointed out, pretty uncontroversially, that some of those results have a genetic component - so thank your parents even if just a little. "you assume it's purely genetic" is pure hyperbole.
> You've sent me the distribution of lipids across all age groups, done for research purposes.
Yeah, exactly, why would that not be relevant? These are the distribution of lipid profiles in the NHANES dataset that is used to guide clinical care throughout the Western world. Modern medicine care is based on research.
> In clinic you rarely test anyone in those younger age groups for lipids as screening starts at 40 for men and 50 for women.
In the US it starts a bit younger. And again, rare is a hyperbole. We routinely screen pediatric patients in the US - that is standard of care. So....
> Are you ordering lipids on healthy 20 year olds?
Yes, of course - not that rarely.
If a healthy 20 year old has no record of being screened in childhood I will screen to rule out FH, obvi.
"healthy" is a nebulous concept - I consider it appropriate to order lipids on what I deem a healthy 20 something with risk factors (family history, certain childhood illnesses, HIV, diabetes - not all young folks with diabetes are unhealthy even if they are not as amazing as you, etc).
> ... My HDL was better than 95% of Dutch teenagers and my triglycerides were better than 90% of 20-somethings.... blah blah blah
Exactly. So, very good, as I already stated, even excellent. But not something that is super rare - 95%tile is 1 in 20, that is not rare.
You were that one that made this about an appeal to authority: "and having seen a lot of lipids/HbA1c I have to say I have never seen results this good in anybody else."
I quoted the literature to not make this some anonymous dick sizing contest - and also because the data is interesting. I admit lipid management is a personal interest - now you can look into why ordering lipids on 20 year olds is sometimes appropriate. You seem to be hung up on being butthurt that the entire conversation is not unconditional praise on your personal accomplishments.
Mostly whole food plant-based. I do eat a lot of candy and I will eat meat sometimes. Usually if I'm at dinner or at someone's house. I avoid all oils.
My exercise is more extreme on the cardio side and has been since high school.
Right now I'm doing 30-40+ miles of running a week. It's on concrete and asphalt with extremely high humidity and I'm still attempting to adapt. Will be starting a strength training program soon because I'm kind of destroying my body.
In the past I've done a mix of treadmill and outdoors. I would like to get back to using a treadmill but don't have access to one right now.
"A lot" is a stretch. There is some evidence in mice and a few hypothesis but I certaintly wouldn't say "a lot." The exception to this I would say is soybean oil. There is a decent amount of research pointing in direction that soybean oil isn't great.
Added oil should be kept at minimum. It doesn't matter the source. But of course this is not the main reason for the obesity epidemic; people just like to find easy culprits instead of looking at the culture around food in the US.
What about whole nuts and seeds from which they're derived? Do they cause the same effect? I find this all a little hard to believe given that obese people tend to consume animal fats at a higher rate than non-obese people, nationwide changes notwithstanding.
> obese people tend to consume animal fats at a higher rate than non-obese people
Tell that to the french. Also, this hasn't been true in the US for a few decades at least. Soybean oil is in pretty much everything now. If you go get a pizza, every single ingredient in that pizza has a healthy dose of either soybean oil or seed oil, from the cheese to the crust.
Cook some bacon and then just use it as normal. These whole elaborate "seasoning" steps are ridiculous. I've never done a single one of them and fry up eggs in mine all the time .
Doesn't cast iron have issues with iron leaching? Not to mention though how much worse Non stick and any other forms are. I've only found ceramic to be better, but can't send it through high heats.
You almost certainly get enough in your diet without having to rely on cast-iron cookware. Is the iron that leaches out even particularly bioavailable? When we talk about iron in the diet we're really talking about iron as part a molecule, not just the raw element.
No, it doesn’t mess up your pan at all. We cook tomato sauces in our cast iron pan all the time and it’s totally fine. Besides, a new pan is like, $12.
I have very low LDL but I’d trade it for higher testosterone levels. Last test check was 200 ng/dl. I’m not a hardgainer body type either, but due to aromatase converting my T into E my body ends up storing more fat.
Decrease in testosterone as you grow older may be cardio protective. It seems like it's currently unknown. Do you have your T levels tested every year?
Personally, I think a lot more blame should be dumped on the gym industry.
Sure, the unhealthy food industry is primarily to blame, but keeping physically fit was something that people did everywhere: sports in the park, exercise at home.
Now we've ended up with a significant number of ultra-toned individuals (I think higher than ever in terms of percentage actually) that spend a significant amount of time making everyone else look bad.
This raising of the bar coupled with the fact that working out need to be done now in special locations that involve a lot more effort than doing 20 push-ups at home, many people have given up entire on exercise as it seems futile to them.
This is a super strange take. Is that claim that since there's a higher proportion of people that are extremely strong, people who aren't fit feel bad when going to the gym since they don't compare? The gym industry takes some blame for people not being fit because .... by making serious strength training widely available it's produced too many too fit people?
> but keeping physically fit was something that people did everywhere: sports in the park, exercise at home.
Nobody took away sports in the park or exercise at home
> This raising of the bar coupled with the fact that working out need to be done now in special locations that involve a lot more effort than doing 20 push-ups at home
Nobody took away 20 pushups at home, or is forcing you to do exercise at a gym.
If anything, the ease of access to high quality information on bodyweight exercises (/yoga/dance class/...) is miles beyond what it used to be - just go to youtube! They're SUPER effective as well!
I know it's a hard argument to make, but what I mean is that if there were fewer gyms that would be a more developed culture of 5-minute exercises at home.
Sure, people can go to youtube and learn. Nobody is stopping them but at the same time nobody in their circle of friends is encouraging this.
Many people need to be convinced by example, and I actually see a lot of friends that would be in better shape if there were advice floating around in casual conversations on how to keep fit within a full schedule.
Gym culture has taken up the bulk of the public discourse space on keeping fit, and it's led to a polarized population.
